Bioelectricity and microcurrent therapy for tissue healing – a narrative review

Source: Poltawski, L and Watson, T: Physical Therapy Reviews 2009 VOL 14 NO 2 (105-114); School of Health and Emergency Professions, University of Hertfordshire, Hatfield, AL10 9AB, UK

Background: Microcurrent therapy (MCT) uses electric currents similar to those produced by the body during tissue healing. It may be particularly beneficial where endogenous healing has failed.

Aim: To review evidence regarding microcurrent in tissue healing and the application of MCT.

Methods: All peer-reviewed studies concerning microcurrent and MCT were sought, and representative literature was synthesized to indicate the scope and weight of current evidence.

Results: Microcurrent appears to play a significant role in the healing process, and MCT can promote healing in a variety of bone and skin lesions. The evidence for other tissues is encouraging but presently scant.

Summary: MCT may have unrealized potential in the treatment of dysfunctional tissue healing and deserves greater attention by researchers and clinicians.

Conclusions: The evidence in support of MCT is convincing enough to justify its inclusion in the clinician’s repertoire for treatment of several examples of recalcitrant bone and skin lesions. Indeed, federal and private health insurance providers in the USA have accepted its use (along with other forms of Poltawski and Watson Bioelectricity and microcurrent therapy for tissue healing) for spinal fusions and hard to heal skin ulcers for some years. In contrast, the lack of substantial and robust human trial evidence for the use of MCT with musculoskeletal soft tissue lesions is frustrating. Clinicians are justifiably cautious when presented with yet another form of electrotherapy, especially when the case for those that are more familiar and well-used, such as therapeutic ultrasound, has been questioned in several reviews.

Yet MCT has several significant features in its favour: there is already substantial evidence that it can promote healing in a variety of tissue types and disorders, especially where other approaches have failed; it may help redress an underlying physiological dysfunction as well as reducing its symptoms; its mechanism of action appears to be as a trigger or facilitator of the whole healing process, unlike some new approaches such as exogenous growth factors, which have specific targets in the healing cascade.

Reported side-effects of MCT are few and minor, and it can be provided by a small, portable generator, over an extended period where necessary, requiring minimal therapist supervision once initiated. The therapy has been shown to be most beneficial when it is used as part of a broader management strategy.

Given these characteristics, the potential for MCT in a range of recalcitrant musculoskeletal disorders is worthy of closer attention by both research and clinical communities.

Electromedicine: The other side of physiology

Source: Kirsch, Daniel L. PhD (2002) Pain Management: A Practical Guide for Clinicians (6th ed.) Boca Raton, Fla.: American Academy of Pain Management. Richard Weiner, Editor. CRC Press. 749-758

Clinical Aspects of Electromedicine: The correct form of electromedical intervention will often have a profound and usually immediate effect on pain. … Even at its present state of evolution, electromedicine offers an unprecedented conservative, cost-effective, fast, safe and powerful tool in the management of the pain patient. As such it should be the first priority on the list of treatment options.

Anti-inflammatory Effects of Electronic Signal Treatment

Source: Odell, Robert H., MD, PhD, and Sorgnard, Richard E. PhD (2008) Pain Physician, 11:891-907 Las Vegas.

Summary: We postulate that pharmaceuticals have a tendency to overwhelm biosystems, a very unnatural progression as evidenced by the side effect profiles. EST works through biosystems and their controls. We have presented multiple mechanisms, most documented and one postulated, which demonstrate initial facilitation and then quick resolution of the inflammatory process to prevent it from leading to chronic inflammation and chronic pain. While complex, all concepts above fit together when taken into the context of signaling cAMP; however, the basic signaling mechanism could easily be the oscillo/torsional ionic action on cyclic AMP. Through this and the other mechanisms discussed, cellular derangements are returned to normal in optimum physiological time.

A paradigm shift in our approach should begin soon. Many patients in chronic pain are simply being undertreated for various reasons. Narcotic medications are being diverted in increasing numbers. Most importantly, a recent study on adverse drug events based on the FDA voluntary reporting system has found the death rate has increased out of proportion to the increase in the number of prescriptions written, and the greatest culprits are pain medications and immune-modulating drugs. The authors emphasized that these findings “show that the existing system is not adequately protecting patients and underscores the importance of recent reports urging far-reaching legislative, policy, and institutional changes.” One purpose of this paper is to get the pain management physician to start to think about modifying the therapeutic approach, which might begin by emphasizing the physics approach as well as the pharmacological approach.

The following from Potter and Funk, written in 1917, still apply: “Success in electrotherapeutics depends on adequate knowledge of physiology and pathology as related to the human body; on a mastery of the laws that govern electricity [physics]; on the possession of efficient apparatus, the achievement of good technique by practice and the good judgment to apply all these requirements … Electrotherapeutics is not a system to be used to the exclusion of other therapeutic measures, but is a worthy addition to any physician’s armamentarium …”

Conclusion: While we believe additional studies involving the treatment of inflammatory processes with EST are important, there appears to be enough evidence to encourage the primary or adjuvant use of EST for inflammatory conditions and for the potential replacement of chemical steroids. EST and the evidence presented have placed us on a threshold of discovery; it is time to apply this knowledge in the clinical setting. The alternative role of EST will depend on the outcomes of well-conducted clinical trials that utilize this reasonable and safe approach.

The use of acupuncture-like electrical stimulation for wound healing of lesions unresponsive to conventional treatment

Sumano H, Mateos G (1999): Am J Acupunct. Sep-Oct;9(5):42-5.

Source: Program of Physical Therapy, Marquette University, Milwaukee, Wis, USA.

Abstract: Based on previous experimental evidence suggesting improved healing of wounds treated with electrical stimulation, we conducted a clinical trial with patients seeking alternative medicine after unsuccessful conventional medical treatment. Electricity was delivered in two forms: (1) For wounds with extensive loss of tissue and/or those that had failed to heal spontaneously, electrical stimulation was delivered via subcutaneously inserted needles surrounding the wound edges and applying a dose charge of 0.6 coulombs/cm2/day; (2) in second-degree burn injuries, lesions were covered with gauze soaked in a 10% (w/v) sterile saline solution and the same dose of electricity was applied as for (1). Forty-four patients were treated with electrical stimulation of the skin; 34 in group (1) and 10 in group (2). Following electrostimulation in all patients in both groups healing proceeded in a thoroughly organized manner, almost regardless of the severity of the type of wound or burn treated. Advantages and limitations of this technique are discussed. PMID: 10513093

Promotion of wound healing with electrical stimulation.

Source: Kloth LC, McCulloch JM (1996) Adv Wound Care., 27(1-2):5-14. Department of Physiology and Pharmacology, School of Veterinary Medicine, National Autonomous University of Mexico, Mexico City.
Abstract: Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings, pressure-relieving devices, hyperbaric or topically applied oxygen, whirlpool/pulsed lavage, ultrasound, topical antibiotics, and cytokine growth factors. All except the last two interventions are physical treatments that create a wound-tissue environment conducive to healing. Unfortunately, many chronic wounds heal very slowly, do not heal, or worsen despite the best efforts of caregivers to promote tissue repair. An intervention commonly used to treat chronic wounds, especially by
physical therapists is electrical stimulation (ES).

The rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body’s endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source. The external current may serve to mimic the failed natural bioelectric currents so that wound healing can proceed. Certain chemotaxis factors found in wound substrates contribute to tissue repair processes by attracting cells into the wound environment. Neutrophil, macrophage, fibroblast, and epidermal cells involved in wound repair carry either a positive or negative charge. When these cells are needed to contribute to autolysis, granulation tissue formation, anti-inflammatory activities, or epidermal resurfacing, ES may facilitate galvanotaxic attraction of these cells into the wound tissue and thereby accelerate healing. PMID: 9069747

The Effect of Microcurrent Electrical Stimulation on the Foot Blood Circulation and Pain of Diabetic Neuropathy

Park, RJ; Son, H; Kim, K et al. (2011) Journal of Physical Therapy Science (23)3:515-518

Source: Department of Physical Therapy, College of Rehabilitation Science, Daegu University, South Korea

Purpose: This study was performed to investigate the effect of microcurrent electrical stimulation on the foot blood circulation and the degree of pain experienced by diabetes patients. Twenty-nine patients with diabetic neuropathy over the age of 60 were randomly divided into an experimental (16 patients, 67.9 ± 8.0 years) and a control group (13 patients, 70.4 ± 4.4 years).

Methods: Both groups walked on a treadmill at a comfortable pace for 50 min/day, 5 days/week for 4 weeks, and each participant’s body weight, body composition, and blood lipid were examined at the baseline and 4 weeks later.

Results: The results show that the foot blood flow rate increment after the intervention was significantly different between the experimental group and the control group, and the VAS was also significantly different.

Conclusion: Based on the study results, we consider that microcurrent electric stimulation of the foot may be helpful for preventing the pain and diabetic ulcers by increasing the foot blood circulation in diabetes patients.

Electrical signals control wound healing through phosphatidylinositol-3-OH kinase-gamma and PTEN

Zhao M, Song B, Pu J, Wada T, Reid B et al. (2006) Nature. Jul 27;442(7101):457-60.

Source: School of Medical Sciences and Department of Ophthalmology, University of Aberdeen, Aberdeen AB25 2ZD, UK.

Abstract: Wound healing is essential for maintaining the integrity of multicellular organisms. In every species studied, disruption of an epithelial layer instantaneously generates endogenous electric fields, which have been proposed to be important in wound healing. The identity of signaling pathways that guide both cell migration to electric cues and electric-field-induced wound healing have not been elucidated at a genetic level. Here we show that electric fields, of a strength equal to those detected endogenously, direct cell migration during wound healing as a prime directional cue. Manipulation of endogenous wound electric fields affects wound healing in vivo. Electric stimulation triggers activation of Src and inositol-phospholipid signaling, which polarizes in the direction of cell migration. Notably, genetic disruption of phosphatidylinositol-3-OH kinase-gamma (PI (3) Kgamma) decreases electric-field-induced signaling and abolishes directed movements of healing epithelium in response to electric signals. Deletion of the tumour suppressor phosphatase and tensin homolog (PTEN) enhances signaling and electrotactic responses. These data identify genes essential for electrical-signal-induced wound healing and show that PI (3) Kgamma and PTEN control electrotaxis. PMID: 16871217

Electro-membrane microcurrent therapy reduces signs and symptoms of muscle damage

Lambert MI, Marcus P, Burgess T, Noakes TD (2002). Med Sci Sports Exerc. Apr;34(4):602-7.

Source: MRC/UCT Research Unit for Exercise Science and Sports Medicine, P.O. Box 115, Newlands, South Africa. Purpose: Delayed onset muscle soreness (DOMS) occurs after unaccustomed physical activity or competitive sport, resulting in stiff, painful muscles with impaired function. Acustat electro-membrane microcurrent therapy has been used to treat postoperative pain and soft tissue injury; however, its efficacy in reducing symptoms of muscle damage is not known.

Methods: Thirty healthy men were recruited for a double-blind, placebo-controlled trial. The muscles of their nondominant arms were damaged using an eccentric-exercise protocol. Subjects were then randomly assigned to treatment with either Acustat or a matching placebo membrane for 96 h and monitored for a total of 168 h.

Results: Subjects in both groups experienced severe pain and swelling of the elbow flexors after the eccentric exercise. After 24 h, the elbow joint angle of the placebo group had increased significantly more than those in the Acustat group (13.7 +/- 8.9 degrees vs 7.5 +/- 5.5 degrees; placebo vs Acustat, P < 0.05), possibly as a consequence of the elbow flexor muscles shortening. For the first 48 h after exercise, maximum voluntary contraction of the elbow flexor muscles was significantly impaired in the placebo group by up to 25% (P < 0.05), whereas muscle function was unchanged in the Acustat group. Peak plasma creatine kinase activity was also lower in the Acustat group (peak = 777 +/- 1438 U.L-1) versus the placebo group (peak = 1918 +/- 2067 U.L-1; (P < 0.05). The membranes were well tolerated by the subjects in both groups without any adverse effects.

Conclusion: These data show that treatment of muscle damage with Acustat electro-membrane microcurrent therapy reduces the severity of the symptoms. The mechanisms of action are unknown but are likely related to maintenance of intracellular Ca2+ homeostasis after muscle damaging exercise. PMID: 11932567

Microcurrent therapy: a novel treatment method for chronic low back myofascial pain

McMakin, Carolyn R, MA, DC. (2004) Journal of Bodywork and Movement Therapies. Apr (8)2:143–153

Source: Fibromyalgia and Myofascial Pain Clinic of Portland, 17214 SE Division Street, Portland, OR 97230, USA

Abstract: Chronic low back pain associated with myofascial trigger point activity has been historically refractory to conventional treatment (Pain Research and Management 7 (2002) 81). In this case series study, an analysis of 22 patients with chronic low back pain, of 8.8 years average duration, is presented. Following treatment with frequency-specific microcurrent, a statistically significant 3.8- fold reduction in pain intensity was observed using a visual analog scale. This outcome was achieved over an average treatment period of 5.6 weeks and a visit frequency of one treatment per week. When pain chronicity exceeded 5 years, there was a trend toward the increasing frequency of treatment required to achieve the same magnitude of pain relief. In 90% of these patients, other treatment modalities including drug therapy, chiropractic manipulation, physical therapy, naturopathic treatment and acupuncture had failed to produce equivalent benefits. The microcurrent treatment was the single factor contributing the most consistent difference in patient-reported pain relief.
These results support the observation that rigorously designed clinical investigations are warranted.

Acupuncture Treatment Reduced Phantom-Limb Pain and Sensation

Medical Acupuncture

Volume 25, Number 1, 2013
Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2012.0928

Synopsis: This study reviewed current publications to determine if acupuncture therapy had been shown to have a positive effect on the symptoms of the phantom-limb syndrome.

Avazzia technology, especially combined with the Avazzia MEAD, can be used as a needleless form of acupuncture.

Nerve Stimulation Cuts Down on Migraines

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: February 11, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Synopsis: A non-invasive device that electrically stimulates the trigeminal nerve prevented migraines for patients whose episodes could not be controlled by medication alone, a trial showed. The number of days with a migraine dropped significantly, by about two per month, in the supraorbital transcutaneous stimulation group, without a change in the sham control group, Jean Schoenen, MD, PhD, of Belgium’s Liège University, and colleagues found.